Organization
INNOVATIVE CHILDREN'S THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DAYNA JILL BRUNETTE MS, PT (PRESIDENT)
(407) 679-7837
Entity
Organization
Contact information
Practice address
5423 LAKE HOWELL RD, WINTER PARK, FL 32792-1033
(407) 679-7837
Mailing address
4819 FISKE CIR, ORLANDO, FL 32826-4278
(407) 679-7837
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
FL
225XP0200X
Pediatric Occupational Therapist
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890816800
—
FL
Enumeration date
11/13/2006
Last updated
01/24/2011
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